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Autism is not known to affect when menarche (the onset of menstruation) occurs, which is usually between the ages of 11 and 13. Many factors can affect when a first period occurs, including but not limited to:
overall health
family size and health history
health and nutrition habits
psychological factors, such as stress
environmental factors, such as exposure to toxins
socioeconomic and demographic status.
Hygiene and routine care
Establishing routines for good hygiene is key to maintaining positive health through the lifespan of autistic women. There is more openness around discussing menstruation as well as options for managing related issues, compared to when many current adults started puberty. A PCP, family practitioner, or gynecologist can advise patients and caregivers about information and issues surrounding menstruation. Clinicians and caregivers can consider where autistic patients are in their reproductive timeline to ensure an understanding of topics such as:
terminology and language for talking about menstruation
blood flow and frequency, and what characterizes a “normal” period
importance of menstrual calendar and cycle tracking
how to manage tampons, cups, pads, and period-proof underwear
role of caregivers or group home staff in monitoring and assisting menstrual processes to assure good hygiene.
Side effects and symptoms
Menstruation is not static; physical and emotional changes continue throughout a woman’s reproductive years. What is normal for one person may not for another. Recent studies indicate that autistic women have higher rates of menstrual issues than is typical of their peers, such as irregular cycles, painful periods (dysmenorrhea), and excessive bleeding. Cramps, nausea, and abdominal pain are common side effects; however, any changes in intensity or frequency should be discussed with a woman’s clinician, especially if they are severe enough to interfere with the ability to work or attend school.
Premenstrual syndrome (PMS)
Physical and behavioral symptoms related to cyclical hormonal fluctuations that occur before a period begins are known as premenstrual syndrome (PMS). PMS is more common in autistic women and can be particularly difficult to manage. Symptoms such as the ones listed below should be brought to the attention of a woman’s clinician:
Physical
changes in appetite
fatigue
migraines
nausea
seizures
worsening irritable bowel syndrome
Emotional
anxiety
depression
mood swings
aggression toward caregivers.
Addressing menstruation-related Issues
In some cases, patients and caregivers may want to consider menstrual suppression to provide relief for menstruation-related mood and behavior changes. Contraceptive medications are typically used to suppress the hormones that control menstrual flow. The decision to use these medications should be discussed among the patient, clinician, and, where appropriate, the caregiver/guardian who helps with medical decision making. That conversation should include discussing:
interactions between contraceptive medication and other medications
medical or digestive issues, such as IBS, that might affect the absorption of contraceptive medication
risk factors for potentially dangerous side effects, such as blood clots
the rationale for using contraceptive medication and its impact on decisions surrounding sexual activity
risks and privacy considerations for patients who live in independent and group home settings
revisiting contraceptive medication decisions as women approach midlife and menopause.
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More Resources
AAHR has more information on conditions often seen in autistic adults, advice for care givers, tips for maintaining good health, and more.
